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目的 :总结双侧颈淋巴结清扫术在处理声门上型喉癌颈部淋巴结转移癌中的临床意义。方法 :对76例声门上型喉癌患者在切除原发灶同时 ,将术前诊断双侧颈淋巴结转移的 33例进行同期双侧颈清扫术 (同期清扫组 ) ;一侧颈部淋巴结转移的 43例行一侧颈清扫术 ,随诊中发现对侧转移再行 2期对侧颈清扫术 (分期清扫组 )。结果 :同期清扫组 3年生存率为 81.5 % (2 2 / 2 7) ,5年生存率 6 1.5 % (16 / 2 6 ) ;1例术后当天死于脑压增高。分期清扫组 3年生存率为 6 9.2 % (2 7/ 39) ,5年生存率 2 7.8% (10 / 36 ) ;1例术后当天呼吸道梗阻死亡。结论 :声门上型喉癌双侧颈转移淋巴结同期清扫术 ,比双侧分期清扫术期能明显提高患者的生存率。术中尽可能保留双侧颈内静脉 ,必要时行血管吻合重建颈内静脉 ,能减少术后的并发症。
Objective: To summarize the clinical significance of bilateral cervical lymph node dissection in the treatment of supratentorial laryngeal cervical lymph node metastasis. Methods: Totally 76 cases of supraglottic laryngeal cancer patients undergoing resection of primary tumor, 33 cases of bilateral cervical lymph node metastasis were diagnosed by synchronous bilateral neck dissection Of 43 cases of lateral neck dissection, follow-up found contralateral metastasis 2 contralateral neck dissection (staging group). Results: The 3-year survival rate was 81.5% (2 2/27) in the concurrent cleaning group and 6 1.5% (16/2 6) in the 5-year group. One patient died of increased intracranial pressure on the day after surgery. The 3-year survival rate was 67.2% (27/39) in 5 patients and 2 7.8% (10/36) in 3-year survival rate. One patient died of airway obstruction on the day after operation. Conclusion: The simultaneous neck dissection in supraglottic laryngeal carcinoma can significantly improve the survival rate of patients with bilateral neck dissection and lymph node dissection. Intraoperative as possible to retain the bilateral internal jugular vein, vascular anastomosis necessary reconstruction of the internal jugular vein, can reduce postoperative complications.